AN
INAUGURAL DISSERTATION
ON THE
MEASLES.
SUBMITTED TO THE EXAMINATION
OF THE
Rev. WILLIAM LINN, D.D. P.T. President;
AND OF THE
TRUSTEES AND FACULTY
OF
QUEEN'S COLLEGE, NEW-JERSEY;
FOR THE DEGREE OF
DOCTOR of MEDICINE,
WITH THE RIGHTS AND IMMUNITIES THEREUNTO
APPERTAINING.
BY CHARLES BUXTON,
OF NEW-YORK.
QUÆ PRÆSENTI OPUSCULO DESUNT, SUPPLEAT ÆTAS.
DAN.
NEW-YORK:
Printed by T. and J. SWORDS, Printers to the Faculty of Physic of
Columbia College, No. 27, William-street. 
1793.

 
 

TO
Doctor JOHN BARD,
Whose Reputation as a Practitioner stands
eminently distinguished;
AND,
Who unites in the Character of a Physician,
every Accomplishment which can adorn
the Gentleman:
This DISSERTATION
Is respectfully inscribed,
In Testimony
of the high Esteem and grateful Acknowledgment of
his obedient humble Servant,
CHARLES BUXTON.

 
 

AN
INAUGURAL DISSERTATION
ON THE
MEASLES.
UPON reflecting on the variety of distressing diseases
to which our fellow creatures are daily exposed, from
unknown causes, we are led by nature, irresistibly,
from their great importance to ourselves, to investigate
the sources from whence they arise, and trace their
effects by gradation.
Unfortunately for the science of Medicine, the result
of these inquiries has in all ages proved, in a great
measure, unsatisfactory. In no class of diseases perhaps,
has this been more notorious than in the contagious,
though frequently of the highest consequence, from the
great mortality often induced by its rage. From these
considerations, I feel an inclination to choose for the
subject of my Dissertation, one of those diseases that are
frequently epidemic; not from any desire of appearing
as an author, but principally in compliance with the
rules 

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rules prescribed in this University, to candidates for its
honours. It is therefore, taken for granted, that every
liberal person who may favour these sheets with a peru-
sal, will freely pass over any imperfections that may be
noticed; especially as some opinions may be advanced,
on which Physicians are considerably divided.
DEFINITION AND HISTORY.
THE most accurate definition of this disease, is that
which has been delivered to us by the illustrious
CULLEN, in the following words.*
Synocha contagiosa, cum sternutatione, epiphora, et
tussi sicca rauca.
Quarto die, vel paulo serius, erumpunt papulæ
exiguæ, consertæ vix eminentes, et post tres
dies in squamulas fursuraceas minimas abe-
untes.
The first accounts of this disease, like those of the
small-pox, have been handed down to us by the Arabian
Physicians: it has been particularly described by RHA-
ZES, who observes, that the contagion first appeared in
Egypt about the year 580, and spread its baneful influ-
ence into Asia, from whence it became imported into
Europe and America. By the indefatigable industry of
SYDENHAM, we have been favoured with the history
of this disease, as it appeared epidemically in England
in
* Vide Nosologiæ Methodicæ, C. Pyrexiæ, O. Exanthemata, G. xxx.
Rubeola. 

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in the years 1670, 1673 and 1674; and what is some-
what surprising, we are told, by the learned Doctor
MORTON, of the dreadful mortality attendant on it in
the year 1672, which is not even mentioned, to the best
of my recollection, by SYDENHAM; though, to adopt
Doctor MORTON's language, it raged like unto a mild
kind of plague, from whose malignancy neither age nor
sex were exempt.*
The morbillious fever generally makes it appearance
in that season of the year which seems, from concurring
circumstances, best calculated to promote the susceptibi-
lity of the human body to imbibe the contagious matter.†
Hence it is supposed most common in the month of Ja-
nuary, when the cold is pretty severe.‡ In the city of
New-York it prevailed as an epidemic in the months of
November and December, 1788, and January, 1789;
and is known to have raged at Plymouth in the months
of July, August, September and October, 1745.§
Its appearance however, in these months, may be
looked on as an exception to our general rule; but it
is absolutely necessary, in our investigation of this dis-
ease, to make that distinction which is here as strongly
painted by nature as in the small-pox. I would then,
on the present occasion, divide the disease into two spe-
cies,
* At locum dedit MORBILLIS EPIDEMIIS, qui ad instar pestis mitioris,
nulli sexui vel ætati parcentes, adeo meusibus, anni 1672. Vide MOR-
TON Exercitationes, &c. Appen. p. 427.
† For a description of our climate I would refer the reader to the inge-
nious observations in the MEDICAL ENQUIRIES of Doctor RUSH; as, in
my opinion, they contain many remarks applicable to this state.
‡ Vide HOME's Principia Medicinæ—CULLEN's Practice.
§ Vide HUXHAM DE MORBIS EPIDEMICIS, vol. ii. p. 537. 

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cies, the Febris morbillosa benigna, and the second species,
so faithfully related by authors of the highest estimation,
Febris morbillosa maligna.*
We shall now proceed to describe the first species, viz.
The FEBRIS MORBILLOSA BENIGNA.
The first symptom, or sensation of indisposition ob-
served by the patient, is the same here as in the begin-
ning of fevers in general; that is, he feels uncomfortably
chilled and trembling, alternated by flushes of heat,
which increasing the uneasiness, is soon succeeded by a
constant and intense fever, with this difference, that in
this disease the patient is always more or less affected
with hoarseness, and in some instances with a pretty dry,
sharp cough† for ten or even fifteen days before the
fever, with considerable difficulty of respiration.—The
tongue exhibits no change on the first day, except being
rather whitened; the eye-lids a little inflamed, with an
increased flux of tears that flow down the cheeks, at-
tended with a desire of rest.
These are the general appearances which the eruptive
fever puts on for the first two days, after which period
they gradually increase in violence; particularly, the
function of respiration is more obstructed; the soreness
and inflammation of the eyes increase; the thirst in
many becomes almost insupportable, attended with great
anxiety and languor.
In infants, a looseness often occurs a short time be-
fore the eruption.
The
* Doctor WATSON's paper in the Lond. Med. Observ. vol. iv. art. xi.
† Vide HOFFMAN. 

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The symptoms continue to grow more violent till
near the fourth day, sometimes a few hours longer, when
the face looks somewhat swelled and fresh-coloured; at
the same time a number of little spots or specks become
visible, which grow in size till many run into one ano-
ther, producing a variety of confluent figures.
The eruptions on the face being thus completed, the
neck, arms and breast, with the other parts of the body,
become successively attacked. I have seen one or two
instances where these eruptions have been first noticed
on the breast; but here I could not observe the pimples
to be so conspicuous as they are commonly found to be
on the face, presenting merely a bright red colour.* As
soon as the eruption is finished, we find ourselves disap-
pointed; for though the symptoms are not aggravated,
they remain in a great degree unabated, except the sick-
ness at stomach and vomiting: yet the cough, fever
and difficulty of breathing are not unfrequently exaspe-
rated: when this happens, the drowsiness, loss of appe-
tite, flow of tears to the eyes, all continue till about the
sixth day, when the countenance changes its appearance
by a roughness of the skin; this continuing two days,
they disappear, and are soon followed by the eruptions
on the other parts of the body in succession.
About the ninth day the skin scales off, leaving the
body as if dusted over with some farinaceous powder,
which is often followed by an itchy sensation.
B The
* STD. de Morbillis, anni 1670. 

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The cough here too frequently remains, and that very
troublesome; attended often with symptoms of an affect-
ed breast, at other times with a diarrhœa.
The ninth day often proves fatal to such infants as
have laboured under severe catarrhal symptoms.
"Nono plerumque die suffocantur infantes, ex nimio
seri acris affluxu."
FEBRIS MORBILLOSA MALIGNA.
WE now come to the consideration of the malignant,
as a distinct species, which may be done with the greatest
propriety; for I am of opinion, that there can be no such
disease as that which CULLEN notes as his second species,
on the authority of SAUVAUGE,* which I hope satisfac-
torily to prove when I come to speak on the causes.
On the authority of the celebrated WATSON, and
other respectable gentlemen, we have been induced to
make this natural subdivision.† The symptoms which
WATSON relates evince themselves, first, by inflamed
watery eyes, cough, and universal debility, succeeded
generally by restless nights.—"On the next day the
fever usually rose to a considerable height, attended with
pain and heaviness in the head, at which time the erup-
tions appeared, so that most frequently on the second day
the measles were visible on most parts of the body; the
cough
* Rubeola (variolodes) papulis discretis eminentibus.
† Doctor WATSON. Lond. Med. Observ. vol. iv. art. xi. Vide Diss.
Med. Inaug. auctore JAC. W. ROBERTS. MORTON's Appendix de
Morb. Epidemici.

(11)
cough and inflamed eyes grew worse: the patient now
complained of great heat, oppression, and restlessness:
the breathing was generelly difficult, with no expectora-
tion; the skin was usually dry, the fauces of a deep red
colour, and the tongue most frequently foul: the thirst
was great; the pulse was very quick, but seldom full;
and they complained of great weakness. The eruption,
heat, and inflammatory symptoms continued in the man-
ner just now mentioned, more or less, according to the
severity of the disease, four or five days, and then went
off; in some instances they continued a few days longer,
but in the greater number, the eruptions were gone at the
end of the fourth day. This I consider as the first stage
of the disease.
"The second, or last stage of the malignant measles,
began after the febrile heat was over, and the eruptions
had disappeared. The watery eyes in many were now
turned into a grievous soreness in that organ, which
lasted in some a considerable time. The cough, oppres-
sion, and difficulty of breathing continued equally severe,
and sometimes more so than during the eruption, at-
tended with great restlessness and anxiety, with scarce
any expectoration: the thirst was abated; the pulse was
quick, but low, and frequently irregular; the debility in
many was extreme, especially at this period if the pa-
tient was teased with purging stools. By this time they
were greatly reduced in their flesh. If in this state a
delirium came on, it generally indicated that death was
not far off."
On 

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On the above species of measles, we are presented
with some remarks by Doctor J. W. ROBERTS, in his
Inaugural Dissertation at Edinburgh, in 1786, where he
mentions its appearance in the island of Antigua, in
1782:—That the sick, on the second day, had the pulse
more full and frequent, with great weariness of the
body, and a visible degree of inflammation about the
tonsils; others had the eruption on this day: about the
fourth day, the inflammatory symptoms subsiding, were
followed by the most alarming appearances, attended
with a low, weak pulse, and generally went through
a similar ccurse with that already quoted from Doctor
WATSON.
CAUSES.
PREVIOUS to our explaining, or entering on the
method of cure, it will be proper to trace the causes of
measles, as the indications which are to be given ought
naturally to be founded on the knowledge of them.
There are certain states or conditions of the human
body, which render it unsusceptible to the attack of the
small-pox, measles, &c. after having once received the
infection: what these states, or changes induced in the
animal œconomy are, we know not; but the fact is
self-evident.
The body at any age, if it has not previously laboured
under the measles, &c. is most generally ever after pre-
disposed to its attack: this predisposition probably con-
sists, 

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sists, first, in the patient's never having had the fluids
assimilated by the action of this ferment,* as a phlo-
gistic diathesis, together with all those causes that may
debilitate the body, either directly or indirectly, as cold,
fear, anxiety, and fatigue.
The OCCASIONAL CAUSE,
I believe, will be acknowledged to consist in a specific
contagion. How the contagious matter is received, has
been an object of much inquiry; but it can answer little
purpose to enter here upon a discussion of this subject,
whether it arises by contact with diseased persons, from
absorption through the pores of the skin, or in respira-
tion by the lungs. The latter of these opinions, however,
I am induced to believe, happens more frequently than
the former, as the stimulus of the contagion is insuffi-
cient to rouse the extreme vessels of the skin into action,
which has been proved by the application of variolus
matter to an arm for twenty-four hours, without being
followed by the disease.†
The infection is then received by breathing the sur-
rounding air alone; yet how these morbific particles are
generated, I cannot explain, without insurmountable
objections: we shall, therefore, from its known effects,
receive it as a matter of fact, that the atmosphere does
often become the receptacle of certain noxious matters,‡ 
that,
* CULLEN, DXCVII.
† See Medical Enquiries by Doctor RUSH.
‡ A locis pessimi acris, ab aquis vitiosis atque etiamne dormiant sub-
umbra nucis juglandis, ne que sub taxo, aut sub pino, aut sub buxo ar-
bore. Ær quidem juxta hasce arbores instar veneni ledit. Vide PROSPER
ALPINUS, p. 201. 

(14)
that, when applied to the human body, do certainly pro-
duce diseases of particular kinds and violence. Thus,
the effects of marsh effluvia in producing intermitting
fevers; putrid effluvia from animal matters, as the cause
of low fevers; the breath of persons labouring under
small-pox, or the perspirable matter surrounding their
bodies inducing the variolus fever: In short, we might
go on almost without end in enumerating instances.
PROXIMATE CAUSE.
UNDER this head, we find the opinions of medical
gentlemen much divided; however, from facts which in
the course of our Dissertation we mean to advance, it is
hoped, that the proximate cause of the measles will be
demonstrated to exist in the blood. Some suppose the
proximate cause to be in the contagion; others, that of
a particular diathesis; and some, that of a ferment.
That the fluids of the body become assimilated by this
ferment, is proved from inoculation in this disease, with
a greater degree of certainty than in that of the small-
pox.* If this is true, as it evidently appears from
Doctor HOME's ingenious and useful experiments, the
fanciful theory of Doctor MILMAN, on the non-exist-
ence of diseases in the blood, must fall to the ground,
and the visionary hypotheses, as he is pleased to call them
by way of ridicule, in many instances will not only exist,
but continue sound theories;† and the vitiated or diseased
state
* Vide HOME's Medical Facts.
† Preface to MILMAN on Scurvy. 

(15)
state of the blood will not be found to reside wholly in
the supposed nature of the matter, though we are not
capable of ascertaining, from the difficulty of the subject,
the precise alteration thus induced, it probably being of
too subtle a nature ever to be investigated so far as to
remove every objection that may be advanced.
The constituent parts of the blood being thus assimi-
lated, in a degree, to the nature of the poison, form the
proximate cause of this disease; that is, during the act of
the fermentative process; by which operation the con-
tagious matter becomes generated in a greater or lesser
degree, agreeable to the habit or constitution of the pa-
tient. The contagious particles stimulate the whole
system, and produce the fever; and, as it is only the finer
parts of our fluids that are thrown off by perspiration,
the more gross and acrid particles are retained, and sti-
mulate the mouths of the excretory ducts; which occa-
sions the primary inflammation that occurs in every
pimple, in the same manner as is observed by Doctor
WALKER, in his elaborate treatise on the small-pox.
DIAGNOSIS.
TO distinguish one disease from another is absolutely
necessary, by marking out accurately those symptoms
that occur, and which might possibly deceive the judg-
ment to the injury of the patient. In every dubious
case, 

(16)
case, the appearances which compose our diagnosis will
be readily distinguished, by attending to the following
circumstances:
From the scarlet fever, by its being free from cough or
any catarrhal symptom.* A soreness of the throat in
the scarlatina, at an early period, and its eruptions are
more diffused, of a brighter colour, and not so eminent
as the measles.† The eruptions appear generally more
in patches, of a bright red, and spread so much as to
unite, and render the skin entirely covered.
From miliary fever. The miliary fever most frequently
happens to lying-in women. The hot stage is attended
with great anxiety and sighing: the heat of the body
being great, soon produces sweating, preceded by a sense
of pricking in the skin; the perspirable matter possessing
a particularly disagreeable odour.‡
From catarrh it is known by the hoarseness and dry
cough constantly attendant on morbilious fever, together
with the affection of the eyes and sneezing. An atten-
tion to the prevailing epidemic will always afford consi-
derable assistance in forming a just distinction.
The disease with which the incipient symptoms of
measles might be blended, and disappoint our judgment,
is that of the small-pox. But here also, the stages are
well marked by the flow of tears from the eyes, occa-
sioned by inflammation or debility; frequent sneezing,
as if the person had caught cold, with a hoarse, dry
cough;
* CULLEN, DCLVI.
† The pimples in measles have somewhat the appearance of flea-bites.
‡ CULLEN's Outlines, DCCXV. 

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cough; all of which precede the attack of measles, and
never that of variolus fever: further, by the pimples not
rising sufficiently eminent to be noticed by the eye, nor
forming pustles, but ending in scales, which naturally
peal off.
The eruptions attendant on the variolus fever, on the
contrary, run into suppuration, and all its concomitant
symptoms abate; but here they are mostly increased.
PROGNOSIS.
IN forming a just prognostication of the future event
of a disease, it is highly proper that we deliberately
reflect upon the past appearance of the symptoms, with
the patient's constitution previous to its being diseased,
the present affections, and the seasons of the year: these
will enable us to form a better judgment. It has been
observed by SYDENHAM, that measles for the most part
are of a simple inflammatory kind, seldom or ever at-
tended with any danger, if carefully treated. This re-
mark is probably too general, as we find that it frequently
proves fatal, though treated, in all its stages, by the most
diligent physicians.*
The event may be pronounced favourable, in propor-
tion as the eruptive fever has gone through its course
with more or less regularity; the catarrhal affection not
aggravated, but gradually growing less troublesome; the
C bowels
* Vide WATSON's Observ. HOME, &c. 

(18)
bowels unaffected with great and frequent discharges.
Copious evacuations from the bladder, and gentle perspi-
ration on the surface of the whole body, are all desirable
marks.
When the eruption is advancing slowly, attended with
restlessness, anxiety, convulsion or epileptic fits, the
most imminent danger may be apprehended. Profuse
hæmorrhages are always to be dreaded.*
Our prognosis in the malignant kind, is to be drawn,
first, from the debility induced. If there is a great pros-
tration of strength, colliquative sweats, diarrhœa, dysp-
nœa, restlessness, great anxiety, with distressing cough
and extreme difficulty in breathing, much is to be feared.
Doctor HOME remarks, that a certain impending death
may be suspected, when the eruptions turn suddenly of
a livid hue, or strike in with delirium. Difficult degluti-
tion, corrosive ulcers in the throat, pains of the head,
great dread of light from soreness of the eyes—these,
with sudden diminution of strength, followed by diarr-
hœa and griping, coldness of the extremities, and hæ-
morrhages, with certainty presage the event.
GENERAL OBSERVATIONS.
THE measles are frequently succeeded by very trou-
blesome and dangerous symptoms; for, as Doctor CUL-
LEN observes, it is not uncommon, even when they have
been
* Vide Principia. Med. Oper. HOFFMAN. 

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been of a mild kind, to find them followed by various in-
flammatory affections, particularly opthalmia and phthisis.
HOFFMAN likewise mentions particular affections: but
the most remarkable is that of gutta serena. In short, I
believe there is scarce a disease, either of an inflammatory
or debilitated kind, but what has sometimes been known
to ensue soon after the measles, though affections of the
breast and abdominal viscera are most frequent. When
we come to our method of cure, we shall note the means
best calculated to obviate these particular sequela.
We shall now examine the propriety of what has been
said on the measles, as combined with other fevers. It
has been mentioned by some physicians of eminence,
that measles have been complicated with small-pox, in
such a manner, that both the eruptions have appeared at
one and the same time, producing very alarming symp-
toms. With great deference to the judgment of such
gentlemen as relate these phænomena, we must beg leave
to doubt the possibility of truth in such narrations, since
we think it can be proved by substantial arguments, that
such actions in the human body are not only inconsistent
with reason, but incompatible with the principles of
morbid action on the animal œconomy. It will, I be-
lieve, be granted, that the matter generating small-pox,
is specifically different from that which creates measles,
as is known from the effects; consequently, we assume
it as a matter of fact, that no two inflammatory fevers of
a contagious kind can exist in the same body at the same
time. Let us allow for a moment, that a person should
be inoculated with a lancet armed with the contagious
fluid 

(20)
fluid of each disease; what might we expect? Should
we see diagnostic marks of each, and find the specific
eruption appear? Most certainly not, because no system
could possibly withstand such a violent conflict. There-
fore, as the constitution is susceptible of but one action
in a part at a time, such an inoculation would probably
induce one or other of the diseases, and after it had gone
through its febrile course, the other might likely ensue.
It will be unnecessary to say any thing respecting local
complaints preceding, or attendant on the fever; for, as
Mr. HUNTER observes, a man may have the pox and
small-pox at the same time; that is, parts of the body
may have been contaminated by the venereal poison, and
the small-pox may take place, and both diseases thus
appear together, but not in the same parts; the one being
a local disease, the other an idiopathic fever, as we have
before noticed. 
We will endeavour to illustrate this principle further,
by relating one of the many cases that occurred under
Mr. HUNTER's own observation.
"On Thursday, the 16th of March, 1775, I inocu-
lated a gentleman's child, in whose arms it was observed
I made large punctures. On the Sunday following, he
appeared to have received the infection; a small inflam-
mation or redness appearing round each puncture, and a
small tumor above the surface of the skin having been
observed. On the twentieth, and on the twenty-first,
the child was feverish; but I declared that the fever was
not variolus, as the inflammation had not advanced since
the nineteenth. On the twenty-second, a considerable
eruption 

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eruption appeared, which was evidently the measles;
upon this the sores on the arm appeared to go back, be-
coming less inflamed. On the twenty-third, he was very
full of the measles; the punctures on the arms being in
the same state as on the preceding day. On the twenty-
fifth, the measles began to disappear. On the twenty-
sixth and twenty-seventh, the punctures began again to
look a little red. On the twenty-ninth, the inflamma-
tion increased, and there was a little matter formed.
On the thirtieth, he was seized with fever. The small-
pox appeared at the regular time, went through its usual
course, and terminated favourably."
Further, I think it very probable that the different pe-
riods after inoculation, before the approach of the erup-
tive fever, can with propriety be accounted for upon no
other basis, than that of some antecedent affection and
peculiarity of constitution. There are many instances
on record, wherein the eruptive fever has not made its
appearance for fourteen or even twenty days after the
introduction of variolus ferment: this, then, can be ac-
counted for on no other principle than the afore-men-
tioned. Mr. HUNTER asks it as a question, Does not
the cure of some diseases depend upon the same prin-
ciple? The suspension, or cure of a gonorrhæa, by a
fever, may be an instance of this kind. As an addi-
tional strength to what we have advanced, I consider
the observations of the late learned Professor, Doctor
ALEXANDER MONRO, of Edinburgh, who relates some
instances of measles and small-pox being succeeded by
each 

(22)
each other.* As a matter of perhaps little present utility,
more than as a singular circumstance, we wish to ob-
serve, with those who entertain an idea that diseases may
be communicated to the fœtus in utero, that we cannot
avoid thinking it somewhat probable, from considering
its nourishment in that state, together with the follow-
ing case, sent to Doctor DUNCAN, and related by him
in the thirteenth volume of his Commentaries:† Two
or three days after the delivery of a child, the physician
was called to give his opinion concerning an eruption
which had now made its appearance on several parts of
its body, to the no small alarm of the parents; he pro-
nounced the eruption to be that of the small-pox, which
afterwards fully proved the propriety of his judgment,
for the pox maturated kindly, in the usual manner of an
easy distinct small-pox. The author of the above his-
tory concludes by informing us, that the grand-mother
of the said child, who was upwards of sixty (in good
health) says, that she was born with the small-pox.
These observations from a gentleman on whose vera-
city confidence may justly be placed, tend unquestionably
to prove, and overturn every prejudice that can prevail
against the idea of diseases being communicated from
the mother to the fœtus in utero.
* See MONRO's, sen. Works, p. 698.
† Vol. xiii. p. 318.
APPEARANCES 

(23)
APPEARANCES ON DISSECTION.
THOSE who die in measles, particularly children,
generally receive their death by a great flux of serum to
the lungs, which produces suffocation; in others, a
hectic fever ensues, with swelling of the abdomen, which
terminating fatally, we discover, upon dissection, an en-
largement of the mesenteric glands, and latent vomicæ
in the lungs.* The best information we can derive on
this head, is from the papers of the judicious Doctor
WATSON, who observes that few died in the first stage
of the malignant measles, several on the two or three
first days of the second, and more between the second
and third weeks: yet there were a few who remained so
much debilitated as to die in more than a month after the
first attack. In one who died of a dysenteric evacuation,
there was discovered a mortification of the rectum: in
six others, one or more parts of the body were found
sphacelated. It is remarkable, that the girls who died,
most usually became mortified in the pudendum: two
who had ulcers in the mouth and cheeks, became so cor-
roded by them, that the cheeks, from the internal ulcers,
sphacelated externally before they died: one of these
had the gum and jaw-bone so much destroyed by the
corrosive matter, that most of the teeth, on that side,
dropt out before death.
The
* HOFFMAN loco citato. Lond. Med. Observ. Art. xv. vol. iv. 

 

(24)
The bronchial tubes were found but little charged
with mucus, even in those who died under difficult respi-
ration, and at some length of time after the eruption and
fever had subsided. The pulmonary vessels were preter-
naturally distended and obstructed; the whole substance
of the lungs being very tender. In a girl who died on the
nineteenth day, the pleura was seen strongly to adhere in
many places; an incipient sphacelation of the left lobe,
with a distention of the lungs; part of the jejunum
much inflamed, containing many worms. Lastly, he
remarks in another who died suddenly at the end of three
weeks, when his complaints were apparently no worse,
that his breathing had all along been difficult, with colli-
quative purging a few days before his death; that he had
complained much of a sharp pain under the left scapula.
Upon opening the thorax, the blood vessels of the lungs
were found much enlarged, and a sphacelus of consider-
able extent in the left lobe: this, by corroding the blood
vessels, occasioned an hæmorrhage, which nearly filled
the left cavity of the breast. The sphacelated part of
the lungs contained a considerable quantity of a putrid,
dark-coloured, highly offensive sanies.
Thus we have concisely delivered a detail of those
appearances which came under the observation of that
accurate philosopher, Doctor WATSON, whose name
we have already mentioned with great satisfaction.
METHOD 


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METHOD OF CURE.
OUR success in the cure of diseases depends on our
knowledge of their proximate causes; but as it often
happens that this information cannot be obtained, our
indications, therefore, must be drawn from the most
urgent symptoms.
I. To remove the phlogistic diathesis.
II. The alleviation of troublesome catarrhal symptoms.
III. To obviate the effects of debility, and tendency of the
fluids to putrefaction.
IV. To prevent the bad effects which often ensue.
I. The first consideration is to remove the phlogistic
diathesis. The most efficacious manner of answering
this purpose, will be,
1st. By diminishing the action of the heart and arte-
ries.
2d. By the use of calomel and opium; and,
3d. By strict adherence to the antiphlogistic plan.
For answering this indication, we of course must
notice blood-letting. The utility of this remedy in
diminishing the quantity of blood, and reducing the tone
of the sanguiferous system, is sufficiently obvious: how-
ever, there are few objections that can be raised to its
free use in the incipient stages, if we take for our direc-
tion the following circumstances:*
1st. The nature of the prevailing epidemic.
D 2d. The
* See CULLEN's Outlines.



 
 

(26)
2d. The season and climate in which the disease oc-
curs.
3d. The degree of phlogistic diathesis present.
4th. The period of the disease.
5th. The age, vigour, and plethoric state of the pa-
tient.
6th. The effects of the blood-letting that may have
been already practised.
It will be proper to consider whether, from the ap-
pearance of the epidemic, it has or has not a malignant
aspect; if it should, the lancet must be cautiously used,
particularly as the measles advance, and we have reason
to expect great debility to follow: on the contrary, if we
have not these apprehensions, it may be called into our
aid with more freedom, always keeping in mind its
effects, and the degree of phlogistic diathesis present.
Urgent symptoms of the pneumonic kind may probably
require frequent bleeding; but this must be judged from
the age and vigour of the patient, as it is observed that
children bear these evacuations but indifferently.
Mercury and opium. Though there may appear a kind
of inconsistency in my classing, as a means of taking off
the phlogistic diathesis, the use of calomel and opium, in-
stead of cathartics and emetics, I am induced to do it, not
only from analogical reasoning from its utility as a spe-
cific in the endemial diseases of India, but from the solid
basis of the experience of an eminent physician in Scotland,
who has proved its success in almost every inflammatory
affection that occurred in an extensive practice of nearly
eighteen years.
I shall 

(27)
I shall submit the explanatory part of its operation on
the body to some gentleman who may be more capable
of obviating those objections which arise in the mind,
and confine myself to facts.
It may be worthy remarking, that this remedy met
with the countenance of that learned character, Sir
JOHN PRINGLE. Doctor HAMILTON, in his letter to
Doctor DUNCAN,* observes, that he was induced to give
this medicine a fair trial, from reasoning, by analogy,
on its good effects in hepatitis, after some blood, as the
case might require, being taken away.† From this, he
was led to try it in a case of peripneumony; "For,"
says he, "its liberal use in inoculation, in the modern
way, had borne testimony of its power in abating in-
flammation." In the case of pneumonia, he was asto-
nished by its success, as well as in many other instances
of the same kind under a great variety of circumstances;
particularly in women far advanced in pregnancy, who
were snatched from the jaws of death after every other
means had failed to relieve them. 
It has also been attended with the happiest effects in a
vast number of other cases, consisting of phrenitis and pare-
phrenitis, inflammations of the intestines and other parts
within the abdomen, child-bed fevers with high inflam-
matory symptoms, and inflammatory angina. Doctor
HAMILTON also expressly says, that he has known many
a life
* Medical Commentaries, vol. ix. p. 191.
† It is unnecessary to say any thing respecting the use of mercury in
either the acute or chronic hepatitis; for in India it is a remedy esteemed
as a specific with as much confidence as the Peruvian bark in intermit-
tents. 

(28)
a life saved in the symptomatic, variolus, and morbilious
peripneumony. From such an extensive practice then,
as fell to the share of this gentleman, and such a length
of time, may we not conclude, that, after bleeding and
evacuating the contents of the stomach and bowels, we
may, with safety and advantage, administer opium with
calomel to our patients, with a view of relieving the
affections of the breast? I think we may, and ought to
embrace the opportunity to prevent those dangerous
symptoms that might otherwise arise.
The proportion of opium and calomel must be regu-
lated according to the age of the patient: the composi-
tion may be agreeable to Doctor HAMILTON's method,
viz. from five to one grain of calomel, and from one to
one-fourth grain of opium, and a dose given every six,
eight or twelve hours, as the urgency of the symptoms
may require. It has been observed, that by the use of
some weak and warm diluent while taking three or four
doses, the inflammation commonly gave way: but if
no relief was obtained (which was rarely the case) the
bleeding was repeated and followed again by the medi-
cine, till the disease resolved by sweating or purging, or
more commonly by both, or by a ptyalism being raised.
If the fever was high, a little emetic tartar and cam-
phor were added. He further observes, that he never
found any medicine whatever with the last addition so
certainly, speedily and effectually produce a relaxation
of the surface, and plentifully discharge from its pores,
with the advantage of increasing the evacuations by stool
and urine: "From which," says he, "it would appear
that 

(29)
that the glandular secretions, in general, are most essen-
tially promoted by this composition." In the malignant
kind, this promises to be a very serviceable remedy, as
patients under those situations will not admit of bleeding
in any great degree:* the lancet, therefore, had better
be laid aside, to give place to more efficacious means.
Antiphlogistic regimen. The antiphlogistic plan, in the
first species of disease, is highly necessary, from the most
obvious causes. It is not requisite to introduce every
particular, more than that the patient should be kept as
much as possible from animal diet, and liberally supplied
with vegetables: his drink should consist of tepid fluids,
prepared chiefly from farinaceous matters. The free
enjoyment of temperate air will always be beneficial;
but not so free an exposure as in small-pox, unless the
disease happens to be of the malignant kind, which most
frequently occurs in moderate weather, when repeated
changes of fresh cool air become essentially requisite.
The air of a sick chamber, when warmed to about sixty-
eight degrees of FAHRENHEIT's thermometer, will be
found most comfortable and pleasant: if colder, it would
probably have a tendency to increase the catarrhal affec-
tion with the pain of the breast.
II. The alleviation of troublesome catarrhal symptoms.
The catarrhal affections often prove distressing from
the beginning of the fever. To relieve these symptoms,
nothing seems better calculated than the constant use of
calomel and opium. This medicine, by its action on
the
* London Medical Observations. 

(30)
the glands of the mouth and fauces, effectually promotes
a plentiful secretion of the mucus, by which it affords a
speedy relief in dry, obstinate catarrhus coughs, particu-
larly when persisted in until the mouth becomes affected
by it: at the same time, the use of mucilagenous drinks
will be serviceable, as they sheath the parts.
If the catarrh is unattended with any other symptom,
would not the Peruvian bark and wine accelerate the
cure?
III. Our third indication is to obviate the effects of debi-
lity, and tendency of the fluids to putrefaction.
To answer this intention, the patient must be indulged
with a more liberal diet, such as broths, jellies, and the
like, with a moderate use of wine diluted. In the ma-
lignant kind, the griping, colliquative stools may be im-
mediately relieved by occasional clysters of thin mutton
broth, with a few drops of laudanum. The sick cham-
ber ought to be kept well ventilated, and of a comfortable
temperature; the patient's clothes frequently changed,
and every thing removed that may in the least offend
the organs of smelling.
The patient's diet here should consist of the most easy
of digestion, and such things as are applicable, as anti-
septics, accompanied with the free introduction of bland
liquids gratefully acidulated. Perhaps the Peruvian bark
would not here be followed by those disagreeable affec-
tions usually ascribed to it, if the calomel and opium be
carefully given at the same time, under such restrictions
as observation alone can dictate.
IV. To

(31)
IV. To prevent the bad effects of measles.
This very important indication is probably of as much
consequence to mankind, as any subject that can be
drawn from the science of Medicine.
As a means the most promising to release our fellow
creatures from that dreadful train of diseases to which
they are exposed after the measles, I think we may, from
analogy, urge the practice of inoculation with full as
much propriety, if not more than ever was done in the
small-pox. It is presumed unnecessary to enter upon a
discussion, in this place, of the advantages or disadvan-
tages attendant on inoculation for the small-pox, as the
business has long since been introduced into general prac-
tice, and the benefits arising therefrom are self-evident
to mankind.
Doctor MONRO, in his account of the small-pox in
Scotland, in the year 1764, introduces a table of inocu-
lation, wherein we see the number of deaths that hap-
pened to 5726 persons, to be only 72: the number of
deaths when the infection was received by the natural
way, was universally acknowledged to be much greater.
Since, then, by the experience and industry of that hu-
mane man, Doctor HOME, of Edinburgh, we are in-
formed that this disease can be propagated by inoculation,
I am fully of opinion, that I shall render mankind some
service if I can be in any degree a means of introducing
inoculation for measles into general practice, and over-
turn those prejudices that have been entertained against
it by physicians.
I shall 

(32)
I shall take the liberty of relating a few of those ex-
periments that have been made on this subject, which
are most worthy of note in this place, referring the
reader, for further satisfaction, to the work from which
they are taken; and then draw some general conclusions.
EXPERIMENT I.*
"March 21st. A child of seven months old, with a
scabby head, running behind the ears, and an eruption
over its body for three months, but otherwise healthy,
was inoculated by the blood taken from a measly child
two days before. This was not the fittest subject that I
would have chosen to begin with, but no other could be
got. We had an opportunity of seeing the mildness of
the disease, and of its effects on these eruptions.
"27th. The child was a little hot all last night, and
had sneezed often this morning. The tongue was white,
and eyes watery. The wound on the right arm was
dried up, but that on the left was running plentifully.
There was no inflammation on either.
"28th. Was hot and restless last night. Continued
to sneeze, but no cough.
"29th. Observed three pustules on the face, and one
on the back, of a very florid colour. Still sneezes.
Coughed thrice this night. Hot and restless last night.
"30th. About a dozen out, and of a very florid co-
lour. Sneezing less. No sore eyes. Child very cheer-
ful.
"April
* These experiments were made in the year 1758. See HOME's Me-
dical Facts and Experiments. 

(33)
"April 1st. A few more measles are come out, and
larger than the former, which were now beginning to
dry. Sneezed a little, but no cough. A little restless
during the night.
"2d. Still sneezing. Coughed three times. A little
restless in the night, but quite cool all the day. A few
more out in the face, the former gone.
"3d. Spots still out. The scabs on the head, and
running behind the ears dried up. 4th. Measles going off.
"This child has been free of all eruptions ever since."
EXPERIMENT II.
"This, and the following experiment, was made on
two sisters, who had a cough all winter; but were other-
wise florid and heathful. The blood was taken the day
before, so that the cotton was yet moist. They were
inoculated April 20th.
"The eldest, about six years, turned hot, thirsty, a
little feverish, with a white tongue, and diminished ap-
petite the next day after she was inoculated. I am apt
to think that this was rather owing to fear from the in-
cisions, or to cold, than to the nature of the disease, as I
never have seen the matter affect others so soon.
"27th. Hot and restless in the night. Sneezes. Has
had a looseness last night. No appetite. Tongue white.
Thirsty. Pain in the back part of her head.
"28th. Much the same, but purging gone. A great
quantity of water comes out of her eyes, so that she
wets many cloths in a day. Her eyes cannot bear the
smallest light, but not in the least inflamed.
E "30th. 

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"30th. Has had the measles out since yesterday. Pulse
quite calm. A great quantity still of sharp humour from
her eyes. No appetite.
"May 1st. Her eyes less weak, and the running di-
minished. Measles out.
"2d. Eyes well, and the measles gone."
EXPERIMENT III.
"The youngest was three years old, and began, April
27th, to be hot in the night, and to sneeze.
"28th. Started sometimes last night. Cool and easy
through the day. Tongue white.
"29th. Not hot last night; but sneezes sometimes.
"30th. Some measles out. Not hot, and no cough.
Tongue white.
"May 1st. Not quite so easy as yesterday.
"2d. Measles pretty large. More drought.
"3d. They were still to be seen out, but disappeared
next day."
EXPERIMENT IV.
"A sister of the two former, aged eight years, was
inoculated May 3d, with the same blood, now 14 days
old, but carefully kept in a glass. 10th. Somewhat un-
easy to-day. 11th. Pain in her head. Pulse very little
affected. Running at her eyes, but no inflammation.
Loss of appetite, and drought. Sneezes much, and coughs
a very little. 12th. Much the same. Some spots have
appeared. 13th. About two dozen out. Hot, and sneezes.
15th. All the measles gone. This child was out all the
day in the open air, till the day of eruption."
It 

(35)
It will not be worth while to relate any more cases,
as those we have already transcribed are sufficient to an-
swer the object in view. It remains only to observe, that
Doctor HOME has clearly proved the propriety of com-
municating the measles to children of every age after this
manner; and that a little blood taken from one of the
red spots contains an ample quantity of the morbillious
matter to propagate the disease.
The eruptive fever, in the inoculated measles, com-
monly happens about the sixth day, when the patient
feels its effects in the night only. The stages occur at
more stated periods than in the small-pox. The alarm-
ing symptoms that often occur in the natural way, as the
cough, violent fever, sore eyes, pneumonia, or hectic,
have never been known to ensue upon inoculation:
hence it follows, that this disease, like the small-pox,
becomes mitigated in its violence by inoculation. The
running of the eyes and sneezing are as strong in the
artificial as in the natural species; but, that often danger-
ous attendant, the cough, almost entirely disappears. The
crisis of the artificial, like the natural, shews itself by
purging.
From all these circumstances, noticed on the authority
of Doctor HOME, we are decidedly of opinion, that it
would be a great blessing to society to render the practice
of inoculation in measles general; since, in fact, the benefits
that result from this operation are equal to what can be
expected in the small-pox. I would therefore recom-
mend the practice, as the most powerful means of obviat-
ing the common consequences of measles.
In 

(36)
In cases where persons labour under the disease natu-
rally, they are often troubled, for a considerable length
of time, by pains in the breast, with short, dry coughing.
I should here, as in the regular stages of the disease, re-
commend bleeding, in proportion as the patient may find
relief thereby, with the use of calomel, opium and tartar
emetic combined, to promote expectoration, and remove
any remaining phlogistic diathesis.
For the treatment of all the diseases that may be con-
sidered as the result of measles, I refer to those writers
to whose province it may belong.
If the advice here given be seasonably adopted, it is
presumed the consequences related will seldom, if ever,
be met with in the practice of our profession.
NOTHING further remains, but that, on this occa-
sion, I return my grateful thanks to those gentlemen
who have aided me in the different branches of my edu-
cation, and in particular to those medical characters, in
the city of New-York, to whose friendship I feel myself
peculiarly indebted; and among whom, I am pleased in
having it in my power to enumerate the names of
Doctors ROMAYNE, MOORE, MITCHILL, and R. KIS-
SAM.—To Doctor SAMUEL BARD, Dean of the Faculty
of Physic in Columbia College, who, during three years
spent under his instruction, manifested towards me the
kindest and most friendly attention, I am happy on this, as
I shall be on all other occasions, to testify my warmest ac-
knowledgments. 
THE END.